Learning Objective #1: Describe pain ratings and words as well as relationships among anxiety, pain, and distraction in adolescents experiencing allergy skin testing

Learning Objective #2: Address adolescent developmental issues that impact choice of nonpharmacologic interventions to reduce procedural pain

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Purpose: This study piloted the effect of self-selected distraction, a cognitive-behavioral intervention based on developmental tasks of choice and control, on acute pain in adolescents undergoing allergy testing. It's believed to be the first study exploring a nonpharmacologic intervention during allergy testing, an important step in diagnosing allergies and asthma. The incidence of both has been increasing dramatically over the past two decades. Research Questions: What is the effect of self-selected distraction on acute procedural pain perception in adolescents? What is the relationship between level of engagement with the distraction and pain perception? How does anxiety interact with the effect of distraction on pain perception? Method: A post-test, experimental design with random assignment to three groups: self-selected distraction, nurse-selected distraction, and usual care, was used. The self-selected group chose a videotape, music CD, or book-on-cassette from a researcher-developed library. The sample included 32 adolescents ages eleven to seventeen. Pain was measured by the Adolescent Pediatric Pain Tool and the FACES scale. Pre- and post-testing questionnaires measured demographic data, “needle” anxiety, engagement in the distraction, and perceived effectiveness of distraction. Anxiety was measured by the Spielberger State Anxiety Inventory. Results: Participants' pain ratings and word descriptions validated the pain experience. Higher levels of anxiety were correlated with higher pain ratings. Greater level of engagement in the distraction was related to lower pain ratings. An unanticipated finding was a trend toward the highest pain ratings for self-selected distraction, albeit not statistically significant, during the more painful testing phase. Implications: One clinically significant finding was the high cancellation/no show rate, possibly indicating use of an avoidance coping strategy to control anticipatory pain and anxiety. Further research is necessary to test interventions that reduce pain and anxiety and promote participation in allergy testing. Matching coping style with choice of nonpharmacologic interventions is recommended.